Osteoporosis

Question 1

Risk factors for osteoporosis

Answer 1

Increasing age
Parental history of hip or spine fracture
BMI less than 20
Smoking
Excessive alcohol consumption
Drugs including: Antiepileptics, antiretrovirals, glucocorticoids, heparin, aromatase inhibitor‘s, Depo, GnRH agonists and antagonists

Question 2

What is a T-score

Normal
Osteopenia
Osteoporosis

Answer 2

The number of standard deviation‘s above or below mean bone mineral density for healthy young adults

• 1.0 or greater
• 1.0 to -2.5
• 2.5 or less

Question 3

What is a Z score

What’s abnormal

Answer 3

Number of standard deviations from individuals bone mineral density compared to those of the same sex, age, ethnicity

Less than -2.0

Question 4

What are the diagnostic criteria for osteoporosis

Answer 4

T-score -2.5 or less
Fragility fracture
T score -1 to -2.5 and increased fracture risk (FRAX)

10 year probability hip fx greater than or equal to 3%
10 year major osteoporotic fracture greater than or equal to 20%

Question 5

When should repeat bone mineral density screening be performed?

Answer 5

In 4 to 8 years after a normal DEXA

Two years in patients with bone mineral density near treatment threshold

One year for patients at risk of short term decrease in bone mineral density Such as those taking glucocorticoids

Question 6

What are the components of FRAX

Answer 6

Age
Paint
Weight
Prior fragility fracture
Parental history of hip fracture
Current tobacco user
Long-term use of oral corticosteroids
Rheumatoid arthritis
Excessive alcohol intake

Question 7

What’s score on FRAX is necessary to initiate treatment

Answer 7

20% 10 year risk for major osteoporotic fracture

3% risk of hip fracture

**FRAX only valid for women >40

Question 8

When should post menopausal women younger than 65 receive DEXA scan

Answer 8

Those at increased risk of osteoporosis, an 8.4% 10 year risk of major osteoporotic fracture on FRAX should be tested

Question 9

Denosumab

Answer 9

Monoclonal antibody against receptor activator of nuclear factor kB ligand, decreases differentiation of osteoclasts

Discontinuation of linked to severe rebound vertebral fractures

After Discontinuation, alternate antiresorptive treatment should be started immediately

Question 10

Parathyroid hormone related therapies
Teraparatide
Abaloparatide

Answer 10

Anabolic agent that leads to bone formation

Side effects include nausea, tachycardia, hypercalcemia

Use is limited to two years Due to those dependent increased risk of osteosarcoma

Question 11

Romosozumab

Answer 11

Monoclonal antibody against sclerostin
Enhances bone formation and inhibits bone resorption
Adverse effects include hypersensitivity reaction and osteonecrosis of the jaw and atypical femoral fractures

Increased risk of cardiovascular events

Question 12

Which measurements is fracture risk based on

Answer 12

Lumbar spine and hip bone mineral density

Question 13

Bisphosphonates
Alendronate
Risendronate

Answer 13

Antiresorptive

AE: Gastric upset, atypical femoral fracture’s, osteonecrosis of the jaw

Question 14

raloxifene

Answer 14

SERM

AE: VTE AND vasomotor sxs

Question 15

Endocrine society’s treatment recommendations for osteoporosis

Moderate risk

Answer 15

Treat with bisphosphonate and reassess five years after oral or three years after IV bisphosphonate

Question 16

Treatment recommendations for high-risk

Answer 16

Bisphosphonate or denosumab for 5-10 yrs

Estrogen therapy or sermon can be considered as an alternative if patient younger than 60 and less than 10 years past menopause

Question 17

Treatment recommendations very high risk

Answer 17

Treat with anabolic agent for 2 yrs teraperatide, followed by 1 year romosozumab then anti-resorptive therapy

Question 18

RDA recommendations for calcium and vitamin D

Answer 18

Calcium <50 1000 mg daily
>50 1200 mg daily

D age 70 or less 600 IU
>70 800 IU

Supplements have no effect on fracture risk and are not recommended for women that don’t have osteoporosis or D deficiency

Question 19

Contraindication to bisphosphonate

Answer 19

Renal dysfunction

Esophageal disorder